Updated Cochrane Review: Rehabilitation for Long-term Care Residents

Physical
rehabilitation for long‐term care residents may be effective,
reducing disability with few adverse events, but effects appear quite small and
may not be applicable to all residents, say authors of an updated Cochrane review
first published in 2009. There is insufficient evidence to reach conclusions
about improvement sustainability, cost‐effectiveness,
or which interventions are most appropriate, they add. Future large‐scale
trials are justified.

For this update, the authors
searched the trials registers of Cochrane entities, trials and research
registers, and conference proceedings; checked reference lists; contacted
authors, researchers, and other relevant Cochrane entities; and updated
searches of electronic databases in 2011 and listed relevant studies as
awaiting assessment. They selected randomized studies comparing a
rehabilitation intervention designed to maintain or improve physical function
with either no intervention or an alternative intervention in older people
(over 60 years) who have permanent long-term care residency.

Two review authors independently
assessed risk of bias and extracted data. The primary outcome was function in
activities of daily living. Secondary outcomes included exercise tolerance,
strength, flexibility, balance, perceived health status, mood, cognitive
status, fear of falling, and economic analyses. The authors investigated
adverse effects, including death, morbidity, and other events. They synthesized
estimates of the primary outcome with the mean difference; mortality data with
the risk ratio; and secondary outcomes, using vote-counting.

The authors included 67 trials
involving 6,300 participants. Fifty-one trials reported the primary outcome, a
measure of activities of daily living. The estimated effects of physical
rehabilitation at the end of the intervention were an improvement in Barthel
Index (0 to 100) scores of 6 points (7 studies), Functional Independence
Measure (0 to 126) scores of 5 points (4 studies), Rivermead Mobility Index (0
to 15) scores of 0.7 points (3 studies), Timed Up and Go Test of 5 seconds (7
studies), and walking speed of 0.03 m/s (9 studies). Synthesis of
secondary outcomes suggested there is a beneficial effect on strength,
flexibility, and balance, and possibly on mood, although the size of any such
effect is unknown. There was insufficient evidence of the effect on other
secondary outcomes. Based on 25 studies (3,721 participants), rehabilitation
does not increase risk of mortality in this population (risk ratio 0.95).
However, it is possible bias has resulted in overestimation of the positive
effects of physical rehabilitation, say the authors.